Kidney transplantation in HIV-positive adults: the UK experience. (January 2014)

• Record Type: Journal Article
• Authors: Gathogo, Esther N; Hamzah, Lisa; Hilton, Rachel; Marshall, Neal; Ashley, Caroline; Harber, Mark; Levy, Jeremy B; Jones, Rachael; Boffito, Marta; Khoo, Saye H; Drage, Martin; Bhagani, Sanjay; Post, Frank A
• Is Part Of: International journal of STD & AIDS. Volume 25:Number 1(2014:Jan.)
• Page Start: 57
• Page End: 66
• Publication Date: 2014-01
• Subjects: HIV -- AIDS -- end stage kidney disease -- renal failure -- kidney -- transplantation -- dialysis -- calcineurin inhibitor -- antiretroviral therapy -- HIV-associated nephropathy -- HIVAN; Sexually transmitted diseases -- Periodicals; AIDS (Disease) -- Periodicals; 616.951
• DOI: 10.1177/0956462413493266
• Languages: English
• ISSNs: 0956-4624

Abstract

HIV-positive patients are at increased risk of end-stage kidney disease (ESKD). Kidney transplantation (KT) is an established treatment modality for ESKD in the general population. Recent data have confirmed the feasibility of kidney transplantation in HIV-positive patients, and kidney transplantation is increasingly offered to ESKD patients with well-controlled HIV infection. We report clinical outcomes in a national cohort study of kidney transplantation in HIV-positive patients. In all, 35 HIV-positive KT recipients who had undergone KT up to December 2010 (66% male, 74% black ethnicity) were identified; the median CD4 cell count was 366, all had undetectable HIV RNA levels at kidney transplantation, and 44% received a kidney from a live donor. Patient survival at 1 and 3 years was 91.3%, and graft survival 91.3% and 84.7%, respectively. At one-year post-kidney transplantation, the cumulative incidence of acute rejection was 48%, and the median (IQR) eGFR was 64 (46, 78) mL/min/1.73 m 2 . Although HIV viraemia and HIV disease progression were uncommon, renal complications were relatively frequent. Our study corroborates the feasibility of kidney transplantation in HIV-positive patients. The high rates of acute rejection suggest that the optimal immune suppression strategy in this population remains to be refined.